Provider Demographics
NPI:1013271766
Name:RICHARDSON, AMY NOEL (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NOEL
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9932 S 100TH ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3070
Mailing Address - Country:US
Mailing Address - Phone:402-659-4991
Mailing Address - Fax:402-933-6345
Practice Address - Street 1:8011 CHICAGO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3533
Practice Address - Country:US
Practice Address - Phone:402-659-4991
Practice Address - Fax:402-933-6345
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE772235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE286530Medicare Oscar/Certification